Effects of initial nutritional status on the responses to a school feeding programme among school children aged 6 to 13 years in the Millennium Villages Project, Siaya, Kenya

Masibo, Peninah Kinya (2013-12)

Thesis (PhD)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Aim: To assess the effects of initial nutritional status on the responses to a school feeding programme (SFP) among school children in the Millennium Villages Project (MVP), Siaya District, Kenya. Objectives: To establish baseline data on the dietary intake, prevalence of undernutrition, body composition, prevalence of anaemia, body iron stores and vitamin A status in order to assess the impact of the SFP over a 30-month period on the same outcomes. Further, the study assessed the effect of initial nutritional status on the responses to the SFP on growth, the prevalence of anaemia, body iron stores and vitamin A status. Methods: In the MVP, a school meal additional to the children’s usual daily food intake was provided consisting of locally available foods (containing whole fish omena and beef). The meals contributed approximately 25% of the Estimated Energy Requirement (EER), 70% of the Estimated Average Requirement (EAR) for protein, and 18% of EAR for fat. A school meal, additional to the children’s usual daily food intake, was introduced to the control group 6 months into the study as a project scale up initiative. The meal provided 15% EER, 49 % EAR for protein and 10% EAR for fat. A total of 235 children participated in the study and were followed up for 30 months, with 118 in the MVP and 117 in the control group. Statistical analysis included descriptive, Pearson’s chi-square test, repeated measures ANOVA and multivariate logistic regression models. Results: The mean subject age was 7.9 years (2.0 SD) at baseline, and half (51.4%) were boys. More than half of the children (66%) had energy intakes less than the EER. At baseline, the prevalence of stunting, wasting and underweight was 16.9%, 6.0% and 3.6% respectively. Prevalence of linear growth deficit based on height-for-age z-score ≤-1 standard deviation was 48%. Anaemia was higher in the MVP group (82.2%; P < 0.0001) compared to controls (58.1%) while depleted body iron stores was observed in 10.7% of the children. Half of the children in the control group and 30% in the MVP group had an inadequate vitamin A status while 11% of the children had infection/inflammation. At six months after initiation of the intervention, anaemia prevalence was reduced to 41.2% among the controls and 9.3% in the intervention group (P < 0.001). Among the MVP group, children with initial inadequate nutritional status based on weight-for-age z-score WAZ ≤ -1 SD had a higher (P < 0.01) height velocity (2.3 cm/six months) by the 24th month study interval compared to those who had an initial adequate nutritional status based on weight-for-age z-score WAZ > -1 SD. Conclusion: SPF menus were associated with potential for improved growth, gain in lean body mass and reduced anaemia prevalence when inadequate nutritional status was present at baseline.

AFRIKAANSE OPSOMMING: Doel: Om die verband tussen skoolkinders se aanvanklike voedingstatus en die respons op ’n skoolvoedingsprogram (SVP) in die Millennium Villages Project (MVP), Siaya-distrik, Kenia, te bepaal. Doelwitte: Om basislyn data te versamel ten opsigte van dieetinname, prevalensie van ondervoeding, liggaamssamestelling, prevalensie van anemie, ysterstore en vitamine A status ten einde die impak van die SVP oor ‘n 30-maande periode op genoemde uitkomste te bepaal. Verder het die studie ook die effek van aanvanklike voedingstatus op die respons tot die SVP bepaal ten opsigte van groei, die prevalensie van anemie, ysterstore en vitamine A status. Metode: In die MVP is ‘n skoolmaaltyd addisioneel tot die kinders in beide studiegroepe se daaglikse voedselinname voorsien. Die SVP se spyskaarte het bestaan uit plaaslik beskikbare voedsel (bevattende die vissoort omena en beesvleis) en het ongeveer 25% van die kinders se geraamde energievereistes (EER), 70% van hul proteïenvereistes (EAR) en 18% van hul vetvereistes (EAR) voorsien. ‘n Skoolmaaltyd is addisioneel tot die kinders in die kontrolegroep se gewoontelike daaglikse voedselinname ingesluit 6 maande na aanvang van die studie as deel van die MVP se uitbreidingsinisiatief. Dié maaltyd het in 15% van die kinders se energievereistes (EER), 49% van hul proteïenvereistes (EAR) en 10% van hul vetvereistes (EAR) voorsien. Altesaam 235 kinders is by die studiegroep ingesluit – 118 in die MVP en 117 in kontrolegroepe – en is vir 30 maande bestudeer. Statistiese ontleding het beskrywende ontleding, Pearson se chi-kwadraattoets, ANOVA met herhaalde metings, en multivariansie logistiese regressiemodelle ingesluit. Resultate: Die gemiddelde ouderdom van die kinders by basislyn was 7.9 jaar (2.0 SD) en die helfte (51.4%) van die respondente was seuns. Meer as die helfte van die kinders (66%) het ‘n energieinname minder as die EER getoon. By basislyn was die prevalensie van belemmerde groei, uittering en ondergewig onderskeidelik 16.9%, 6.0% en 3.6%. Die voorkoms van onvoldoende lengtegroei gebaseer op lengte-vir-ouderdom z-telling < -1SD was 48%. Anemie was hoër in die MVP groep (82.2%; p<0.0001) vergeleke met die kontroles (58.1%), terwyl 10.7% uitgeputte ysterstore getoon het. Onvoldoende vitamine A status het voorgekom in die helfte van die kinders in die kontrolegroep en 30% van die MVP groep, en infeksie / inflammasie was teenwoordig in 11% van die kinders. Die voorkoms van anemie op ses maande na aanvang van intervensie het verbeter tot 41.2% in die kontrolegroep en 9.3% in die intervensiegroep (P < 0.001). Op 24 maande het kinders met aanvanklike onvoldoende voedingstatus (WAZ < -1SD) in die MVP-groep groter lengtetoename (2.3 cm/6 maande) getoon as hul groepgenote met aanvanklike voldoende voedingstatus gebaseer op WAZ > -1 SD (P < 0.01). Gevolgtrekking: Die skoolvoedingsprogram spyskaarte het die potensiaal getoon tot ‘n verbetering in groei, toename in maer liggaamsmassa en ‘n verlaagde voorkoms van anemie onder kinders wie se basislynvoedingstatus onvoldoende was.

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